Hip Replacement Surgery
Hip replacement is a common and very successful procedure for chronic hip pain that doesn’t respond to more conservative interventions. Hip replacement involves replacing the hip joint with a metal or plastic artificial implant to improve the patient’s pain and range of motion. First developed in the 1960s and refined since then, hip replacements have become the definitive solution to regain pain free mobility. It is estimated that over 300,000 total hip replacements are performed every year in the United States. In fact, modern hip replacement has been regarded by many as the most successful surgery of the century!
Why Would I Need a Hip Replacement?
The most common cause of hip pain requiring hip replacement is a degenerative arthritis. There are several common forms including:
As we age, many of us will develop osteoarthritis, which simply represents wear and tear on the joints – the hip is no different. As the cartilage between the ball and socket of the hip degrades, bone on bone rubbing can occur causing progressively worsening pain. Osteoarthritis can occur as a result of aging, due to congenital issues or even lifestyle issues such as obesity that place added pressure on the hip joint.
An autoimmune disorder known as rheumatoid arthritis can also cause degradation of the hip joint, requiring hip replacement. A common type of inflammatory arthritis, rheumatoid arthritis creates inflammation that damages the protective cartilage in the hip joint, once again causing significant pain, eventually resulting in a replacement.
Post-traumatic arthritis is a form of osteoarthritis that causes joint degradation after an injury to the hip, for example from a car accident or sporting injury. . This form of osteoarthritis accelerates the wear and tear process, causing cartilage to become damaged prematurely and increasing the risk of hip pain.
A hip replacement may also be required due to osteonecrosis, which occurs when blood flow to the ball or femoral head is limited, which can cause the bone to deform and create pain in the hip joint.
How Do I Know I Need A Hip Replacement?
Hip replacement is a semi elective procedure. In other words, while it is the only curative option for chronic, severe hip pain, it is not typically performed in an emergency setting unless there is serious trauma. Patients who need a hip replacement will likely have severely limited activities due to their pain and most have chronic pain and stiffness all day and night.
Many patients do not want to undergo a hip replacement immediately and as such, the first course of action may include medication, followed by physical therapy and even periodic cortisone shots. These therapies are often effective early in the course of treatment, but tend to become less effective as the hip joint continues to degrade.
When coming to your initial consultation at our office, you will undergo a series of imaging tests to understand more about the particulars of your condition. At this point we will discuss the course of treatment that is best for your circumstance as well as post-operative expectations and outcomes, if surgery is required.
How A Hip Replacement Works
Most commonly, a total hip replacement is performed. This means that both the ball of the joint, known as the femoral head, and the cartilage is removed. The femoral head is replaced with a similarly sized metal ball. The damaged cartilage is removed from the socket. A metal replacement socket is implanted in place of the cartilage and a plastic spacer is placed between the ball and socket to create a smooth-moving joint. The new ball and socket joint work in similar fashion to the natural anatomy.
A total hip replacement procedure requires between an hour and an hour-and-a-half of operative time, during which patients will be sedated with general anesthesia. Dr. Basmajian performs the procedure in a minimally invasive manner in appropriate patients, which reduces recovery time and hospital stay as well minimizing pain, blood loss and the risk of infection after surgery. Dr. Basmajian prefers to use the anterior (frontal) approach to the hip replacement to minimize damage to nerves and muscles in the surgical area. By using a natural muscle gap next to the sartorius muscle, we can access the hip without cutting through muscle. The posterior approach is also effective however it does require a longer incision (6-9 inches) and involves cutting nerves and muscles, increasing the chance of postoperative pain.
Depending on the patient’s age, activity level and lifestyle, a partial hip replacement may be more appropriate. This is where the ball is replaced, but the socket is left intact. This is commonly performed in patient of advanced age that have suffered a fracture.
Younger, healthier patients may be candidates for bilateral hip replacement if necessary.
Preparing for Surgery
There are some considerations before surgery that all patient should understand. In the rare event that you experience significant blood loss during surgery, you may be asked to store your own blood before the procedure. You may also have to modify your medication regimen temporarily to ensure your safety during surgery. If you’re carrying excess weight, losing some weight before surgery will improve both perioperative and postoperative results. Smoking must be stopped 6 weeks before surgery. Lastly, during your recovery, your abilities will be limited, and you should have a plan in place for someone to assist with daily activities such as housework, shopping and bathing. You would likely need this assistance for a two to three weeks after surgery, so be sure to line up a caretaker well before surgery.
Early Recovery and Getting Back to Normal Activity
Hip replacement is one of the most gratifying surgeries in medicine as it offers the patient virtually immediate pain relief. Surgical pain can be managed with a short course of over-the-counter or narcotic pain medication. However, the chronic hip pain resolves immediately.
Most patients will spend one to two nights in the hospital during which time they will be asked to ambulate (walk regularly) to speed recovery and reduce the likelihood of a blood clot known as deep vein thrombosis or DVT. As recovery progresses, we expect our patients to walk more, within their physical limits.
Starting soon after surgery and over the course of a few weeks after surgery, physical therapy to strengthen muscles and improve mobility will be required and is key to a successful recovery. Most patients can return to normal activity within eight weeks. Be sure to follow your post-operative instructions closely to minimize the potential of complications.
Realistic Expectations Post-Surgery
Our goal is to restore more normal lifestyle, activity and function with a hip replacement. We expect this to be the case for the majority of patients. In some patients, especially those with congenital hip disorders, their hip function may improve to a degree that they had never experienced before. However, we must remember that most patients undergoing hip replacement are over the age of 50, which means their age creates inherent lifestyle limitations regardless of surgery.
As a rule of thumb, however, much like our natural joints, excess weight and strenuous, high-impact activity can have adverse effects on the hip replacement and shorten its useful life. Lower impact activity, such as walking and swimming, can allow for pain free enjoyment of many activities that you may have avoided for years. These low impact activities also extend the life of the implant.
Young, very active patients who undergo a hip replacement may eventually wear out their new joint. This may lead to a second hip replacement known as a revision. However, this is becoming less common as newer materials last longer. Today, the vast majority of hip replacements last upwards of 20 years.
Risks and When to Call the Office
While the prognosis after hip replacement is excellent in the hands of a highly experienced surgeon, it is still major surgery that comes with risk. While low, there is a risk of blood loss, pain, blood clots, hip dislocation, infection and hardware failure.
Patients will typically follow up with our office a few weeks after surgery, however patients should call us immediately if they experience any of the following potential complications.
- A fever of over 101
- Worsening pain at the incision sites
- Worsening or foul-smelling discharge at the incision site
- Dislocation of the hip joint, especially in early recovery
- Any redness or swelling in the leg. This is often a sign of deep vein thrombosis or DVT
Typically, the benefits of a hip replacement, in the form of reduced pain and improved lifestyle, far outweigh the risks of surgery, however every patient has a unique circumstance. We encourage you to contact our office and schedule appointment with one of our surgeons to discuss whether hip replacement may be the best option for you and answer any questions about the procedure itself and life after surgery.